Rural communities, tribal communities and small towns are amazing places to raise a family! But more than half of all rural counties in the United States are without access to a local hospital where a person can give birth. Rural families face unique challenges in accessing maternity care. The experiences of a rural pregnancy and birth- navigating distance between care providers, travel to appointments, accessing resources relevant to the rural experience, the challenge of getting to a birth location safely- can, at times, leave families feeling like the logistics overshadow the ability to take in the fullness of this new chapter of their family story.
The challenges and stresses of travelling to access maternity and birthing care can impact the health of our families. Stress during pregnancy, and in the time around and after birth, has the ability to impact adaptation to pregnancy and parenting, and to change the physiology of the brains and nervous systems of our unborn children and infants. With one in five women in the United States living with a mental health challenge prior to pregnancy, there is reason for a call to action to support the mental health and wellbeing of rural expectant and new parents. As if this were not enough reason to understand that the way we are born matters, as a rural health educator, advocate and care provider, I also recognize the disparity in birth outcomes for rural families without local hospital birthing care: higher rates of pre-term birth and a greater likelihood of giving birth in a rural hospital emergency department. And these impacts are only the first we have begun to quantify. Most certainly, our understanding of the significant individual, community, social and economic costs of our rural maternity care shortage will grow in time.
Through my Bush Fellowship, I have come crystal clear on a simple message: the way we are born matters. It matters to our families, to our communities, to the fabric of our cultures and our humanity. I understand this first and foremost as a rural woman who has birthed three children, in three very different circumstances. I know, in the deepest most certain way, the events of each of my births mattered to my sense of self and confidence and the way I would mother. My birth stories created the foundation for relationships in my family, the way I would interact with my community, my economic productivity, and understanding of my place in the physical and spiritual world. As a rural healthcare provider, I have walked beside families through the unique circumstances of their pregnancies, births, and parenting time. It is a universal truth that the way we are born and the way we birth matter.
Exploring this rural maternity care access situation, and simultaneously growing my leadership, my vision and my ability to have a greater impact, I have been struck by the profound importance that there are many simultaneous truths present together in the events of a rural pregnancy and birth. It is true that our society proclaims “family values” and healthcare systems claim “mother-centered care,” and equally true that proportionally more U.S. mothers die during or in the time around childbirth than in any other developed nation. It is true that rural hospitals can’t always meet the established standards of obstetric care, and true that an overwhelming number of low-risk pregnancies can safely birth in rural hospitals, birth centers, or in homes. It is equally true that rural families make a choice to live in communities where birth may not be a financially viable healthcare service, and true that there is no “health care” situation more fundamentally, universally human than to birth or to die. It is true that a response to the rural maternity care shortage will take time meandering through policymaking and bureaucracy, and undeniably true that right now, tomorrow and the next day people are pregnant in rural and remote communities.
On fellowship, one has a “justification” a “directive” to listen to the heart pull, to let the passion bubble up and guide action. You have just read a few paragraphs of my heart pull, my passion for the time before and around birth as formative to healthy rural families. My fellowship focus in rural family health began with a renewed commitment to my own health and to return family to the center of my life. Undertaking graduate studies to become a Family Nurse Practitioner at Frontier Nursing University- the birthplace of nurse midwifery and family nursing in the United States- has connected me to nurse leaders, innovators, practitioners and advocates committed to the vision of care for rural families. Training in mind body and integrative approaches to women’s health has provided information for creating new ways to approach and provide whole person, whole family health care. Networking with researchers, project leaders, clinicians, and concerned families affected by the rural maternity care access shortage have led to new collaborations. All of this has transformed my approach to each day, and my understanding of my potential to impact the lives of individuals, families, and groups of people.
At the outset of fellowship, if you had described to me the abundance and diversity of my experiences and projects, I would not have thought it possible without running myself into the ground. At this moment, I am training in women’s integrative and functional medicine, collaborating on a rural maternity care mobile clinic project in Maine, writing a proposal to the Health Resources Services Administration to develop innovative tech approaches to rural pregnancy support, creating a video and website for rural families to navigate their “Amazing Rural Pregnancy and Birth” (www.kristindearrudawharton.com), envisioning new models of rural family care, AND I am en-route to campus in Kentucky to demonstrate clinical skills in preparation for clinical rotations. This abundance has been possible for me to balance through clarity of focus, a huge dose of courage, and commitment to family and self-care. Balance is dynamic. Ultimately, a commitment to physical activity, sleep, time outdoors, water intake, breathing and reframing stress, time with my kids, time alone with my husband, and realistic expectations of my time have all led me to feeling compelled to get active most days- not because I “should”, but because I’ve learned that I can’t keep up with the demands and I can’t feel good if I skip these routines. Making it all happen on a daily basis is possible because of the rock-solid partnership and support of my husband, and flexibility of my children.
One of the transformative realizations about my leadership and future path has been a clear understanding that in order to build out my vision for whole person family and pregnancy care, I will work at a local, regional and national level to make local impacts. It took me a long time to get clear on this. My vision was clouded by “either/or” scenarios I created where I either had to work locally or not, and conflicting emotions, connections, commitments to local community. Through fellowship activities and reflection, I realize now I can have the most impact locally by acting regionally and beyond. But this does not have to come at the expense of providing local care or local involvement and commitment. I can, and in fact I must, work both locally and beyond my immediate geography. It has taken courage to begin to embody this idea. At first, it felt like I was forsaking local healthcare organizations and community members to think about NOT working exclusively locally. After months of devastating and confusing communication about future local work prospects, I began to see that perhaps the doors were not opening locally. This necessitated that I cast my net beyond local to consider future employment and professional involvement. Courage, gentleness, and understanding myself more objectively have allowed me to now see that perhaps I have always been called to work both within and beyond my home community. I have come to appreciate the value of rural healthcare systems, and the value of creating change both from within and from outside of these systems.
Today and for these next six months of fellowship, I continue to lean in to courage, to dream regionally AND locally, to put myself and my family at the center of my life in order to sustain my service and leadership to my community- a community that I am redefining to include rural families and geography everywhere.